Managing a left pleural effusion after aortic surgery

M. Polastri, A. Pantaleo

Physical Medicine and Rehabilitation, and Department of Cardiac Surgery; Bologna University Hospital St. Orsola-Malpighi Polyclinic, Bologna, Italy. gbptap1@gmail.com

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• Cardiology

BACKGROUND: During the first 48 hours after open-heart surgery, patients are at high risk of developing atelectasis and pleural effusions. Reduced lung ventilation in the postoperative period contributes to the development of critical conditions that can be managed with noninvasive respiratory support.

AIM: In this case report, we describe the postoperative treatment of a left pleural effusion that occurred in a patient who had undergone aortic surgery.

MATERIALS AND METHODS: A 68-year-old man with aortic valve regurgitation and a thoracic aorta aneurysm who previously underwent surgery for coronaropathy was admitted to the cardiac department. He underwent aortic valve, ascending aorta, and arch replacement and the frozen elephant trunk technique with an E-vita open prosthesis in the descending aorta. Forty-eight hours postoperatively, a left pleural effusion was observed. Pulmonary CT performed on the same day confirmed almost complete atelectasis of the left lung due to compression phenomena resulting from secretions and pleural effusion. Intravenous diuretic therapy and antibiotic coverage were started. The patient was encouraged to sit as soon as possible. The EzPAP® System (Smiths Medical, St. Paul, MN, USA) with a mouthpiece was used with the patient sitting.

RESULTS: A marked difference was observed in the imaging studies: those obtained on the third day showed a decrease in the opacity of the left lung, which was completely white on admission.

CONCLUSIONS: In our case, the use of EzPAP® allowed lung expansion and mucus clearance using only one instrument.

Published on: 2012/10/17

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